Counseling women on the best forms of birth control cuts the rate of unintended pregnancy, according to a new study.
Not all birth control options are equally effective. The intrauterine device (IUD) and implant—referred to as long acting reversible contraception (LARC)—are more effective than the pill or condom. The failure rate for the IUD is as low as 0.2%; for the pill, that rate is 9%. (It’s even higher for a condom, at 18%.) Yet only 7.2% of the population uses LARC.
That number may increase with better counseling, suggests the new study published in the journal The Lancet. Researchers found that when women are counseled about the effectiveness for various forms, they choose LARC more often and have fewer unintended pregnancies.
The researchers looked at 40 Planned Parenthood clinics in the United States and assigned 20 of the clinics to receive training on counseling and insertion for IUDs and implants. The other 20 offered standard care. More than 1,500 women ages 18 to 25 who visited the clinics—and who didn’t want to get pregnant in the next year—were enrolled in the study.
Sex Ed Books Through the Ages
“Those who look at our bodily dwelling can gain a very good idea of what we are... The care of our body, then, adds to our value,” advised Barbara Wood-Allen in 1897's "Self and Series: What a Young Girl Ought to Know.""When the organs peculiar to woman are displaced or disordered ...pangs shoot through her like winged piercing arrows or darting needlepoints" wrote mail order doctor Lydia Pinkham in 1907. Published by the Christian Education Service, of Nashville, Tennessee, during the 60s, it was written by one of the founders of SIECUS "When the natural God-designed and God-honored sex instinct is perverted and base desire supplants love, in the choice of a companion, the home instinct is degraded, love dethroned and inharmony prevails," wrote Thomas Washington Shannon in 1913."It is probably best, that the life-like illustrations, some of them photographic, in books of human anatomy be kept away from boys of early adolescent age" counseled Maurice Alpheus Bigelow in 1916. "... the woman so under the influence of liquor is, for the time being, little more than a "cave woman," or barbarian, with all the lax sex morality of the latter," wrote R.B. Armitage in 1917This 1928 volume was directed to the "young man whose aim is to be sturdy, strong and successful." "Dr. Norman Carr," the pamphlet informed readers in 1934, "is probably the most widely read author on this subject in the entire world." First issued in 1949, this booklet warned: "Don’t forget that any woman who lets you use her, or who consents easily, is not safe."From 1941, "An intellectual and frank discussion of subjects of Social Hygiene, Physiology, the Science of Sex, Moral Living, Character Building, Motherhood and PreNatal Care." This 1941 manual includes a diagram entitled "Facts you Should Know for Defloration on Bridal Night." This 1943 book kept in simple with little line drawings accompanying text like: "Here is the way you looked when you were ready to be born..." The author of this 1944 guide, Belle Mooney, was touted as "a well-known physician pioneer and lecturer on hygienic and sociological subjects." "Sooner or later your children are going to learn about sex. They ought to. They must," wrote Fathers Rumble and Carty in this 1950 textbook for Catholics. Written in 1950 by pioneering sexologist David Cauldwell, who's credited with inventing the term transexual. In cheerful 1950 parlance it reads: "Lucky boys and girls whose parents, teachers and leaders provide this book for them! It would be a good idea for the old folks to read it too." "The smart writer... who says flatfootedly or insinuates cleverly that sex experience before marriage is necessary for happiness in marriage is a plain liar and an elaborate traitor to young people," cautioned Daniel Lord in 1951."Here is a complete analysis of young people's sexual problems and mores—from kindergarten to college —a comprehensive case-history study of the new rebellion," promised this 1962 paperback."Before boys are ready to get married and start a family, they must at least be able to earn a living," claimed this otherwise very hip Lutheran church publication in 1967."At the most basic level, a concern with sex education must stem from the recognition that human socio-sexual development is a learning process," said this scholarly 1974 journal. This 1974 pamphlet was part of a collection of self help books from Ms. Landers including: “Teen-age Sex. And 10 Ways to Cool It!” and “Love or Sex. And How to Tell the Difference.”From 1983: "Ugly women have boyfriends, mean women have boyfriends, hopelessly insecure women have boyfriends, stupid women have boyfriends, women covered with hideous warts have boyfriends." This 1993 book claims that "classroom sex education is always wrong and always harmful; that it destroys modesty; awakens the passions; promotes sexual activity and fosters acceptance of sexual sins." "Sex is many different things, and people have many different feelings and opinions about it," says this 1994 classic, in admirable understatement.
Read more: Why Schools Can't Teach Sex Ed
After following them for a year, the researchers found that the women who went to a clinic with LARC training were more likely to report getting counseling compared to the women in the control group. They were also more likely to choose an IUD or implant and were less likely to get pregnant during the study period. The rate of unintended pregnancy for the women in the intervention group was nearly half that of the control group (8 women out of 100 in the intervention group, compared to 15 per 100 women in the control group).
The study authors conclude that counseling may strengthen a woman’s perception of her control over her pregnancy risk, and she therefore may choose more effective contraceptives.
“Unintended pregnancy has been one of those basic health issues that has persisted as a stubborn problem in the U.S., especially among 18-25 year olds,” says study author Cynthia Harper, a professor of obstetrics, gynecology & reproductive sciences at the UCSF Bixby Center for Global Reproductive Health. “We’re excited to be able to offer providers an intervention that can help them educate women on the range of FDA-approved contraceptives and to be able to offer the methods with highest efficacy—IUDs and the transdermal implant—along with other more commonly used methods such as the pill.”
Counseling like the kind in the study could take place in places beyond Planned Parenthood clinics, Harper says. “The counseling could be brought to health centers at schools,” she says. “We are also beginning to help develop curriculums for high school students to learn about all of the methods of birth control, including IUDs and implants, so they have the knowledge they need when the time comes for them to make their own birth control choices.”
